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You are not alone with your questions about medical canabis – you may find the answers here.

The term ‘medical cannabis’ covers manufactured cannabis products containing the full spectrum of active substances from the cannabis plant, including cannabinoids, terpenes, flavonoids and more. The products do not hold a marketing authorisation, as they have not been through the conventional application process with the authorities, including clinical trial data. However, they are produced under strictly controlled pharmaceutical conditions to ensure products of high quality, with reproducible levels of active ingredients.

What is medical cannabis?

Medical cannabis is primarily used by patients with chronic illnesses, for symptom relief in cases where effective treatments are lacking, or where conventional drugs don´t have an acceptable efficacy or are poorly tolerated. The doctor can prescribe medical cannabis for any indication in cases of severe illness if considered beneficial. Medical cannabis can be used alone or together with order medications, and it may be used to reduce the dosage and/or side-effects of other medications

Who can have medical cannabis prescribed to them?

All cannabis products with a THC content of more than 0.2% require a narcotics prescription from a doctor and can only be bought from pharmacies. CBD products with a THC level of less than 0.2% can be bought without a prescription outside of pharmacies, but they are then not subject to the special quality and control requirements for pharmaceutical products with regard to active ingredient content and quality, so that the effectiveness and safety of these products is not guaranteed to the same extent as with products from the pharmacy. Therefore, CBD products used for medical purposes should be prescribed by a doctor and bought from a pharmacy

Where can I buy medical cannabis in Germany?

Any doctor in Germany can prescribe medical cannabis for any indication in cases of severe illness if this might benefit the patient. Veterinarians and dentists do not have permission to prescribe medical cannabis.

Who can prescribe medical cannabis?

The adverse reactions observed for medical cannabis are usually mild or moderate and pass within a few hours. In most cases they can be controlled by reducing the dosage and will decline with repeat usage. 

The most well-known side effects of cannabis are those related to the THC content, such as euphoria; these effects might be less pronounced if THC is combined with CBD. Other common side effects of cannabis include dry mouth, nausea, fatigue, dizziness, anxiety and disorientation. More severe psychoactive effects such as hallucinations, depression and paranoia are less common at clinically relevant dosages

. This information is not exhaustive and does not claim to be correct. Your doctor will provide you with comprehensive and individual information about risks and side effects in a personal consultation.

What are the most common adverse reactions?

Most adverse reactions are non-serious when starting with low, clinically relevant dosages of medical cannabis

. Always contact your doctor if mild or moderate adverse reactions do not decline over time with repeat usage, or if you experience severe side effects. The doctor will evaluate whether any adjustments are needed in administration, dosage or product type. You can report adverse reactions via the 

Paul-Ehrlich-Institute's reporting system

, but remember to also inform your doctor at the next consultation about any unwanted effects of your medication.

What do I do if I experience adverse reactions?

Medical cannabis can be prescribed as dried cannabis flowers to drink as a tea or to inhale using a vaporiser. It can also be prescribed as extracts such as oils, which are typically swallowed or placed under the tongue using a dropper. The extracts can also be filled into capsules for oral administration or made into topical products for application onto the skin.

Which formulations does medical cannabis come in?

Because medical cannabis is often used for symptom relief, patients are often treated with other medications at the same time. So it makes sense to consider interactions with other drugs.

When using cannabis in combination with other tranquillising substances such as alcohol, benzodiazepines and opiates, there might be an additive tranquillising effect.

As cannabis is metabolised in the liver, all diseases, or drugs that are administered at the same time, that affect the activity or levels of liver enzymes might influence cannabinoid concentrations in the blood. This is not unique to cannabis but is a general consideration for all drugs containing active ingredients that are metabolised in the liver.

Cannabinoids themselves might also affect the activity of liver enzymes and can potentially influence the concentration of other drugs metabolised in the liver. An important clinical example of this is the increase in the active metabolite of the anti-epileptic drug clobazam when co-administered with CBD.

In relevant cases, the above considerations and theoretical possibilities can be circumvented by adjusting dosages, but there are no identified drugs that cannot be used together with cannabis if necessary, and clinically significant drug interactions are rare

. Please note that the information given here is not exhaustive and does not claim to be correct. Please discuss possible drug-drug interactions with your doctor, who will give you final advice and coordinate the therapy with you.

Are there interactions with other medications?

Usage of cannabis should be avoided during pregnancy. Cannabinoids will reach the foetus through the umbilical cord and may slow foetal growth. Cannabis should also be avoided during breastfeeding, as it is detected in breast milk. Cannabis should be used with caution in patients with severe liver, renal or cardiac diseases. Prescription of medical cannabis containing THC is usually not advised for children and adolescents, and for patients with a history of substance abuse (drugs, alcohol, medication) or psychiatric disorders (such as schizophrenia)

. In these cases, the doctor will evaluate on a case-by-case basis whether the benefits outweigh the risks.

Are there conditions which are not compatible with medical cannabis?

Reimbursement can be given for medical cannabis by health insurance providers if no standard or approved medicine has proven effective for a serious illness and there is a reasonable chance that cannabis will be beneficial for the patient. It is the patient’s responsibility to apply for reimbursement at the health insurance provider, and permission must be obtained before the first prescription is issued. A private prescription, with the patient covering all costs for the medication, is always possible with appropriate medical indication.

Will my health insurance provider reimburse me? 

Medical cannabis products are sometimes simply raw cannabis plant material that has been produced in a strict GACP- (Good Agricultural and Collection Practices) and GMP- (Good Manufacturing Practices) compliant environment from cloned plants that allow for predictable cannabinoid content. Other products are produced as liquids (oils or tinctures) and are made by extracting compounds from plant material using solvents such as ethanol, liquid CO2, etc.

How is medical cannabis produced?

Cannabis legislation is decided on a national level and can differ from one country to the next. It is therefore important when travelling to investigate the local laws and regulations on medical cannabis in transit and destination countries. Medical cannabis may be taken out of Germany if accompanied by a certified attestation and if allowed by the countries visited. For more info, see the section 

'Traveling with narcotics' on the BfArM website

Can I travel with medical cannabis?

From a medical perspective, it is not recommended to smoke cannabis, as the products of combustion are carcinogenic and can be harmful to the lungs. Instead, the flowers should be administered via inhalation through a vaporiser

 or orally as tea. The affiliated physicians at Canify Clincis support this recommendation and explicitly advise against the smoking of cannabis.

Patients should also bear in mind that the combined use of cannabis and tobacco, e.g., as joints, could be construed as poly-drug use, which can lead to the withdrawal of the driving license.

Is it legal to smoke medical cannabis?

It is strictly illegal in Germany to privately grow all varieties of cannabis, regardless of whether for medical or recreational use.

Is it legal to grow my own medical cannabis?

The euphoric/psychotropic effects of cannabis may impair your driving ability, especially at the beginning of treatment. This needs to be considered by the doctor and assessed based on your tolerance and local legislation

. For patients in Germany, driving under the influence of medical cannabis is legally the same as driving under the influence of other drugs that can affect a person’s driving abilities, such as opioids and antidepressants

. It is generally not prohibited as long as the patient medicates as prescribed (§ 24a StVG)

, but the patient is responsible for ensuring that his or her driving ability is not impaired (§316 StGB). Cannabis patients are advised to be in possession of the prescription or a doctor’s certificate while driving.

Can I drive while taking medical cannabis?

In the event of an overdose, keep calm, lie down, and wait for the effects to wear off, as they are generally reversible. The effects of cannabis taken orally will not be noticed as quickly and last longer than the effects of inhaled cannabis, which results in a large and rapid increase of cannabinoids in the blood. An overdose of cannabis is not fatal. Symptoms are typically dizziness, sedation, euphoria, cognitive impairment, sensory and perceptual impairment, clumsiness, dry mouth, hypotension, or increased pulse rate. More severe symptoms from high doses can include panic attacks, severe anxiety, psychosis, paranoia, hallucinations, convulsions etc. If you feel very uncomfortable, contact your doctor, emergency room or pharmacist. The higher the THC content in the product, the higher the risk of experiencing adverse effects – especially if you are an inexperienced user

What should I do in the event of an overdose?

Practical considerations in medical cannabis administration and dosing

. European Journal of Internal Medicine vol. 49 12–19 (2018).

INFORMATION FOR HEALTH CARE PROFESSIONALS

. Cannabis (marihuana, marijuana) and the cannabinoids. (2018).

. Medical Cannabis and Cannabinoids 1, 65–72 (2018).

. Current Opinion in Psychology vol. 38 75–79 (2021).

Medikamente im Straßenverkehr - Fluch & Segen

References

You are not alone with your questions – you may find the answers here.

FAQ

References